What guidelines does the CDC have for reusing and decontaminating surgical masks?

To pursue a spectrum using the surge power approach in the order of traditional, contingency, and crisis capacities, CDC Strategies for Maximizing the Supply of N95 FFRs have been published. N95 FFRs are intended to be disposed of after each application. To help healthcare facilities maintain their supplies in the face of shortages, the CDC developed contingency and crisis plans.

If due to an anticipated shortage, the supply of N95 FFRs is limited, supplies should first be conserved using some strategies.

Conventional Capacity Strategies

Depending on product labeling and local, state, and federal standards, use facemasks.

  • Surgical masks are cleared by the FDA. These are to give protection against the body fluids and used when such exposures, like surgical procedures, are expected.
  • Facemasks that are not FDA-regulated can not protect against splashes and sprays, such as certain process masks that are usually used for isolation purposes.

Contingency Capacity Strategies

Reduction in duration of stay for medically stable COVID-19 patients.

Cancel elective and non-urgent procedures and appointments selectively for which HCP usually uses a facemask.

Place facemasks in a safe and controlled location and include facemasks at entry points for symptomatic patients upon check-in.

Healthcare facilities may consider the removal from public areas of all facemasks. Facemasks may be required at entry points to support symptomatic patients upon check-in. Both facemasks should be mounted in a safe and managed location. This is particularly relevant in areas of heavy traffic, such as emergency rooms.

Enforce the extended use of facemasks.

Extended use of facemasks is the practice of wearing the same facemask without removing the facemask between patient encounters, for frequent close contact encounters with several different patients.

  • When soiled, broken, or hard to breathe through, the facemask should be removed and discarded.
  • Healthcare professionals must take note that their facemask is not touched. They must do hand hygiene immediately if they touch or change their facemask.
  • Healthcare professionals should remove the facemask outside the patient care area.

Restrict facemasks, rather than asymptomatic source control patients, for use by HCP.

Have patients with signs of respiratory infection cover their mouth and nose using tissues or other barriers.

Crisis Capacity Strategies

Cancel all elective and non-urgent procedures and appointments that HCP normally uses a facemask for.

Using facemasks during patient care operations outside the manufacturer-designated shelf life.

If no date on the facemask label or packaging is visible, the facility should contact the manufacturer. The customer can inspect the product visually before use and discard the product if there are problems.

Restricted facemask re-use

Restricted reuse of facemasks is the practice of multiple encounters with different patients using the same facemask by one HCP, but removing it after each encounter. As the potential contribution of contact transmission to SARS-CoV-2 is unknown, care should be taken to ensure that HCP does not touch the external surfaces of the mask during care, and that removal and replacement of the mask are done carefully and intentionally.

  • When soiled, broken, or hard to breathe through, the facemask should be removed and discarded.
  • Not all facemasks are available for reuse.
  • Face Masks which attach via ties to the supplier may not be undone without tearing and should be considered for extended use only, rather than re-use.
  • For reuse, face masks with earloops may be better.
  • If they need to remove the facemask, the HCP should leave the patient care area. To reduce contact with the outer surface during storage, face masks should be carefully folded to mitigate contamination. The folded mask should be placed in a clean, sealable paper bag or breathable container between applications.

Extended Use 

For frequent near contact experiences with many patients, extended use refers to the practice of wearing the same N95 respirator. Extended use is well suited to situations in which one respiratory problem affected multiple patients and they are put together in special waiting rooms. As an alternative for maintaining respirators during previous respiratory pathogen outbreaks and pandemics, prolonged use has been suggested.

Reuse

For multiple encounters with patients, Reuse alludes to using the same N95 respirator but removing it after each encounter. In between encounters, the respirator is stored to be placed on again before the next encounter with a patient. The reuse is practiced for years for pathogens in which touch transmission is not a problem. For example, the CDC advises that a respirator labeled as disposable may be reused by the same worker for the prevention of tuberculosis as long as it remains functional and is used in compliance with local procedures for infection control. Even if N95 respirator reuse is practiced or recommended, some constraints restrict the number of FFR reusable times. Therefore, N95 respirator reuse is called as "restricted reuse." During previous respiratory pathogen outbreaks and pandemics, restricted reuse has been suggested and commonly used as an alternative for conserving respirators.

If extended use of N95 respirators is allowed, administrators of the respiratory protection program should ensure compliance with administrative and engineering controls to reduce possible contamination of the N95 respirator surface and consider additional training and reminders for employees to enforce the need to avoid excessive contact with the respiratory surface. To advise workers to take the following measures to minimize touch transmission after donation, healthcare facilities should establish specific written procedures:

  • The following use during aerosol generation procedures, stop using N95 respirators.
  • After close contact with, or leaving, the treatment area of any patient co-infected with an infectious disease requiring contact precautions, reject N95 respirators.
  • Reject N95 respirators that are contaminated with respiratory or nasal secretions, blood, or other bodily fluids from patients.
  • Perform hand hygiene before and after handling or changing the respirator.
  • Consider using a cleanable face cover over an N95 respirator to mitigate surface contamination.

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